It's Not What You Look At, It's What You Look For

11 Mar It's Not What You Look At, It's What You Look For

Making a diagnosis can be difficult.  Diabetic retinopathy and macular degeneration are easy to diagnose, but you have to know to look for it to see it.  The diagnosis then becomes pretty obvious.  Knowing what to look for is essential to making a correct medical diagnosis.  Retinal disease, such as ARMD and diabetic retinopathy, is easy to diagnose as we can also “see” the eye.

I just read about a 59 year old male who had all the common symptoms of diabetes for several years, yet his doctor treated each symptom separately.  His weight loss was treated with high calorie supplements, his frequent urination was treated as a prostate problem and his multiple nighttime trips to the bathroom were treated with sleeping meds.

He switched doctors and was diagnosed with Type II diabetes.

Just Browsing, But Not looking

Was his first doctor stupid?  Not necessarily, but he failed to “look” for diabetes.  He failed to look for the one diagnosis that could bring all the symptoms together.  He didn’t look for a common denominator.  Had he “looked” for diabetes, he would have checked sugar levels, and then, solved the puzzle.  This doctor was similar to a shopper who is “just browsing.”

Problem Oriented Thinking

The second doctor practiced ‘problem oriented’ medicine.  He was able to find the common denominator of all the “problems” and then knew what tests to order to prove himself correct (namely, serum glucose and hemoglobin A1C).  This doctor was the shopper that went shopping with a finite list of items.

Diabetic Retinopathy and ARMD is Even Easier to Diagnose

Diabetic retinopathy and macular degeneration are even easier to “see.”  Why?  Because I can also “look” at the eye and determine the presence, or absence, of either disease.  Sometimes it takes no testing.

I can rely on my examination for establishing a diagnosis because I, too, know what to “look” for.

In diabetics, I look for blood, microaneurysms, macular edema, exudates, neovascularization and retinal detachments.  Having some of these findings will establish the diagnosis.

So, too, in macular degeneration.  I look for characteristic scarring of the macula, bleeding underneath the retina, drusen and leakage, etc.

Most of the time, if not always, we are able to make a diagnosis by direct examination.  Testing can confirm our suspicions.

What Does This Mean? Because eye docs are able to directly visualize most aspects of your eye, we’re able to tell you with a high degree of certainty, especially with diabetic retinopathy and macular degeneration, if you have the disease or not.  There is usually no beating around the bush.

If there is any doubt, additional testing may be helpful.  To you, the patient, we can offer assurance about the state of your retinal disease.

We know what to “look” for and what to “look” at.